FirstNarration
The United States has dramatically reduced cigarette smoking over the past six decades, but emerging nicotine products and changing attitudes toward tobacco could threaten that progress, according to Shane Jacobson, CEO of the American Cancer Society and the American Cancer Society Cancer Action Network.
In commentary published by U.S. News & World Report, Jacobson argues that stronger prevention programs, tobacco control policies and public health messaging remain necessary as flavored e-cigarettes, nicotine pouches and tobacco imagery become increasingly visible.
He points to the decline in US smoking rates from 42.6% in 1965 to 9.1% in 2025 as evidence of the impact of decades of tobacco control efforts.
Tobacco Remains a Major Public Health Concern
Despite declining smoking rates, Jacobson argues that tobacco continues to impose a substantial health and economic burden in the United States.
He cites more than 490,000 deaths annually linked to tobacco and says tobacco use is associated with at least 12 types of cancer.
He also puts the combined annual cost of tobacco-related healthcare expenses and lost productivity at more than $600 billion.
The concern, according to Jacobson, is that weakening prevention efforts could make it more difficult to maintain the progress achieved over previous decades.
Flavored E-Cigarettes Raise Concerns Over Youth Use
One area highlighted in the commentary is the growing range of flavored vaping products.
Jacobson criticizes the US Food and Drug Administration's recent authorization of four flavored e-cigarette products, arguing that flavors could increase their appeal among younger users.
He cites government data indicating that nearly all young people who use e-cigarettes choose flavored products.
Although youth e-cigarette use has declined since reaching its peak in 2019, Jacobson argues that continued prevention efforts are needed to sustain that trend.
Tobacco Imagery Is Returning to Popular Culture
The commentary also raises concerns about what Jacobson describes as the "reglamorization" of tobacco.
Cigarettes were once heavily associated with movies, television and celebrity culture. Over time, restrictions on tobacco advertising, smoke-free laws, higher prices and public health campaigns contributed to reducing smoking's cultural visibility.
Jacobson argues that tobacco imagery is now becoming more visible again across movies, magazines, music videos and social media.
He cites a Truth Initiative report stating that tobacco incidents in movies increased by 70% between 2022 and 2023.
The commentary also points to recent magazine imagery involving celebrities smoking as examples of tobacco returning to mainstream cultural content.
Social Media Creates New Challenges
The tobacco and nicotine landscape has also expanded beyond traditional cigarettes.
Jacobson highlights the promotion of nicotine pouches through social media influencers, including personalities sometimes described as "zynfluencers."
Unlike traditional advertising, these promotions can appear alongside entertainment, lifestyle and influencer content.
Jacobson argues that algorithm-driven social media platforms provide new channels through which nicotine products can gain cultural visibility, particularly among younger audiences.
Tobacco Prevention Infrastructure Faces Pressure
Another concern raised in the commentary involves federal tobacco prevention resources.
Jacobson says the Office on Smoking and Health at the Centers for Disease Control and Prevention (CDC), which provided tobacco prevention and cessation leadership for more than four decades, has been significantly weakened following staff dismissals.
He argues that reducing public health infrastructure while tobacco and nicotine marketing expands could undermine previous gains.
Jacobson Calls for Renewed Prevention Efforts
Jacobson urges Congress to maintain funding for evidence-based tobacco prevention and smoking cessation programs and ensure that funding is used for its intended purposes.
His broader argument is that the decline in smoking did not happen automatically. Public policy, prevention campaigns, advertising restrictions, higher tobacco prices and smoke-free laws all contributed to changing smoking behavior and cultural attitudes.
The article therefore calls for renewed attention to strategies that have historically been associated with declining tobacco use.
For now, US smoking rates remain far below their levels several decades ago. Jacobson's warning is that maintaining those gains will require continued prevention efforts as vaping, nicotine pouches, social media promotion and other newer forms of nicotine use reshape the tobacco landscape.
